ketorolac ophthalmic

Action and Spectrum

Actions and Spectrum 

Action: 

Anti-inflammatory: Drug belongs to the class of NSAIDs, which work by inhibiting the production of certain chemicals in the body called prostaglandins. Prostaglandins are responsible for triggering inflammation and pain. Ketorolac ophthalmic works by decreasing the presence of prostaglandins in the eye, leading to a decrease in inflammation, redness, and swelling. 

Analgesic (Pain Relief): In addition to its anti-inflammatory properties, drug also provides analgesic effects. One way to relieve eye discomfort is by obstructing the transmission of pain signals within the eye’s nerve network. 

Spectrum:  

Postoperative Ocular Inflammation: Drug is commonly prescribed after eye surgery, such as cataract removal or refractive surgery, to reduce inflammation and manage pain in the postoperative period. It helps to control the discomfort associated with surgical procedures and promotes faster healing. 

Seasonal Allergic Conjunctivitis: Drug can be used to manage symptoms of seasonal allergic conjunctivitis, an allergic reaction that affects the conjunctiva (the clear tissue covering the white part of the eye). It helps to relieve redness, itching, and swelling caused by the allergic response. 

Drug Interaction

Adverse Reaction

Frequency defined  

>10% 

Transient ocular burning/stinging 

1-10% 

Superficial ocular infection 

Ocular irritation 

Superficial keratitis 

Iritis 

Increased ocular pressure 

Corneal edema 

Ocular inflammation 

Ocular pain 

Conjunctival hyperemia 

Corneal infiltrates 

<1% 

Corneal epithelial degeneration 

Dry eyes 

Corneal erosion 

Blurred vision 

Perforation of cornea 

Corneal ulcer 

Corneal thinning 

Epithelial breakdown 

Black Box Warning

Black Box Warning: 

None

Contraindication / Caution

Contraindication/Caution:  

Hypersensitivity: Individuals who have a known hypersensitivity or allergic reaction to ketorolac or any other components of the medication should not use ketorolac ophthalmic. 

Active peptic ulcer disease: Ketorolac ophthalmic, like other NSAIDs, can increase the risk of peptic ulcers and gastrointestinal bleeding. Therefore, it is contraindicated in individuals with active peptic ulcer disease or a history of gastrointestinal bleeding. 

Recent eye surgery: Drug is specifically indicated for use following cataract surgery or corneal refractive surgery. However, it should not be used before or during these surgeries. 

Known bleeding disorders: NSAIDs, including ketorolac, can affect platelet function and prolong bleeding time. Therefore, individuals with known bleeding disorders or those currently taking medications that increase the risk of bleeding should avoid using this drug. 

Severe renal impairment: ketorolac is primarily eliminated through the kidneys. Individuals with severe renal impairment (creatinine clearance less than 30 mL/minute) should not use this drug due to the risk of accumulation and potential toxicity. 

Pregnancy / Lactation

Pregnancy warnings:     

Pregnancy category: C 

Lactation: Excreted into human milk is unknown 

Pregnancy Categories:         

Category A: Studies that were well-controlled and met expectations revealed no risk to the fetus in either the first or second trimester. 

Category B: There were a lack of studies on pregnant women and no evidence of risk to the fetus in animal experiments.   

Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.    

Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.   

Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.    

Category N: There is no data available for the drug under this category

Pharmacology

Pharmacology:  

ketorolac ophthalmic is a nonsteroidal anti-inflammatory drug (NSAID) which is employed in treatment of ocular inflammation and pain following eye surgery. 

Pharmacodynamics:  

ketorolac ophthalmic works by inhibiting the synthesis of prostaglandins, which are mediators of inflammation. It specifically inhibits the enzyme cyclooxygenase (COX), thereby blocking the conversion of arachidonic acid into prostaglandins. ketorolac is a nonselective COX inhibitor that primarily targets the COX-1 isoform, which is involved in the production of protective prostaglandins in the eyes. 

Pharmacokinetics: 

Absorption 

When applied topically to the eye, ketorolac ophthalmic is absorbed into the ocular tissues. The drug effectively permeates the cornea, attaining therapeutic levels within the anterior chamber of the eye. 

Distribution 

Drug remains primarily localized to the ocular tissues and does not significantly enter the systemic circulation in significant amounts after topical administration. Therefore, systemic exposure to ketorolac is minimal when used as an ophthalmic preparation. 

Metabolism 

ketorolac undergoes extensive metabolism in the liver. However, the systemic metabolism of ketorolac is not relevant when it is administered as an ophthalmic solution, as the drug is primarily confined to the ocular tissues and does not significantly enter systemic circulation. 

Excretion and Elimination 

ketorolac and its metabolites are eliminated from the body mainly through the kidneys. The primary route of elimination for ketorolac is through the urinary excretion of the parent compound and its metabolites, resulting in systemic clearance. 

Adminstartion

Administration:  

Hold the bottle of ketorolac ophthalmic eye drops upside down, with the dropper tip facing downwards. 

With your other hand, gently squeeze the bottle to release one drop into the pocket formed by the lower eyelid. 

After instilling the drop, close your eye gently and apply slight pressure with your finger to the corner of the eye near your nose. 

This helps prevent the medication from draining into the tear duct and being absorbed systemically. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: ketorolac ophthalmic 

Why do we use ketorolac ophthalmic?  

Postoperative pain and inflammation: Drug is often prescribed after eye surgeries, such as cataract extraction or corneal refractive surgery, to reduce pain and inflammation in the eyes. It helps in relieving discomfort and promoting healing. 

Allergic conjunctivitis: drug can be used to manage the symptoms of allergic conjunctivitis, conjunctivitis, commonly known as pink eye, is an allergic-induced inflammation affecting the conjunctiva.It helps in reducing itching, redness, and swelling associated with this condition. 

Corneal abrasions: drug may be prescribed for the treatment of corneal abrasions, which are small scratches or injuries on the cornea (the clear, outermost layer of the eye). It helps in alleviating pain and inflammation associated with corneal abrasions, aiding in the healing process. 

Uveitis: Uveitis refers to the inflammation of the uvea, which constitutes the intermediate layer of the eye. Medication forms an integral component of uveitis treatment, aiding in the alleviation of inflammation and its related symptoms.